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New Baby Medical Coding for Office Visits
Alicia: OK. She's got another slide; lotsof knowledge tonight from JoAnne. New Baby Office Visit, we get a lot of questions aboutthis so I'm glad that JoAnne did this particular presentation. JoAnne: Q: How do I bill and get paid fornew baby visits in the Family Practiceé I have more denials than payments. A: This is going to be approached from a billingand coding perspective. I have talked before in just regular billing where you can billa preventive along with a sick visit at the same time adding a modifier25 to, say, 99212that requires a medical necessity.
Talking about a newborn, after a newborn isdischarged home, he will begin to see his physician in the office, depending on whetheror not the pediatrician saw the baby in the , it depends on whether you use a99381 as the Initial Comprehensive Preventive Visit (under age one), or if the didsee the baby in the you would be billing a 99'1. That's very important. If the newborn is identified as having somethingas jaundice or low birth weight, that is considered a medical necessary visit and you would addan EM code with that. Like I said, same concept as if you were billing for an adult visit,you can't combine a wellness and a sick
visit. That part is the easy part, it'sthe billing end of it that is really a pain in the neck. First of all, parents have to enroll theirbabies in the family insurance plan under a separate ID number. They must stress tothe patient when they call the office with their first appointment. I'll explain why;newborn coverage varies by carrier and billing is easier if the office already has the IDnumber. I'm going to point out four examples ofwhy it makes it easier to have the number. Number one, these are valid newborn coverage.If the newborn has not been added to the plan
within 60 days, the payer will reimburse allroutine newborn care under the mother. That's one rule. The next insurance company, thepayer will reimburse the physician under the mother for routine and nonroutine care butonly up to 31 days. Another payer will reimburse under the mother's ID number up to the first61 days of a newborn's life. The last one: All incurred inpatient well newborn servicesare included in the mother's obstetrical stay. If the newborn is not added as a dependentupon the mother's discharge from the , coverage of well newborn care will cease. Why there's a problem, you want to firstcommunicate again to the parents to enroll
as quickly as possible. You need to know therules of the insurance carrier. The reason why it makes it easier to get the ID numberahead of time is because if you're allowed to bill under the mother's name and dateof birth, the computer is automatically going to kick it out because a newborn code doesnot correlate with the mom that was born in 1983. And the one thing I hate in billing is fixingdenied claims. I'm just saying it can be ten minutes to an hour to fix this claim,so even though the rules say, â€œOh, we'll pay under mom,â€� you have to do the workto get it paid.
The last thing is, if a mom and dad leavesand says, â€œOh, I'll call you with the ID number,â€� don't put the encounter formaside. Bill it, even if you know it's going to get denied. The reason is, is that insurancecompanies, they have 60 days, 90 days, a year to bill. You push that aside and if the momdecides to call on the 93rd day, you can't appeal that claim, it's not in the insurancedatabase. So, just get it in there, because you have 90 days to bill, let's assume itdenies; then, you have another 90 days from the denial date. So, it's a lot of work,so I think the front desk should be proactive to get the information as soon as possibleand avoid the whole appeal process. Anyway,
What causes, say, heroin addictioné This is a really stupid question, righté It's obvious; we all know it; heroin causes heroin addiction. Here's how it works: if you use heroin for 20 days, by day 21, your body would physicallycrave the drug ferociously because there arechemical hooks in the drug.
That's what addiction means. But there's a catch. Almost everything we thinkwe know about addiction is wrong. If you, for example, break your hip,you'll be taken to a and you'll be given loads of diamorphinefor weeks or even months. Diamorphine is heroin. It's, in fact, much stronger heroin thanany addict can get on the street because it's not contaminated by allthe stuff drug dealers dilute it with.
There are people near you being given loads of deluxe heroinin s right now. So at least some of themshould become addictsé But this has been closelystudied; it doesn't happen. Your grandmother wasn't turned intoa junkie by her hip replacement. Why is thaté Our current theory of addiction comes inpart from a series of experiments that were carried out earlierin the 20th century.
The experiment is simple: you take a rat and put it in acage with two water bottles. One is just water, the other is waterlaced with heroin or cocaine. Almost every time you run this experiment, the rat will become obsessedwith the drugged water and keep coming back formore and more, until it kills itself. But in the 1970s, Bruce Alexander,a professor of psychology, noticed something oddabout this experiment:
the rat is put in the cage all alone. It has nothing to do but take the drugs. What would happen, he wondered,if we tried this differentlyé So he built Rat Park, which isbasically heaven for rats; it's a lush cage where the rats would havecolored balls, tunnels to scamper down, plenty of friends to play with,and they could have loads of sexâ€” everything a rat about town could want. And they would have the drugged waterand the normal water bottles.
But here's the fascinating thing: in Rat Park, rats hardlyever use the drugged water; none of them ever use it compulsively;none of them ever overdose. But maybe this is a quirk of rats, righté Well, helpfully, there was a humanexperiment along the same lines: the Vietnam War. 20% of American troops in Vietnamwere using a lot of heroin. People back home were really panicked,